FULGMETM Journal

Background

At one institution, coordinators reported a palpable sense of isolation and burnout driving high turnover. Initial survey data confirmed the problem: 56.2% lacked sufficient resources; 31.3% reported burnout. One coordinator noted a need for “more communication and social connection.”

Methods

Coordinators were surveyed in early 2024 and again in early 2025. The PCAW committee organized six events between March and November 2024 at no cost: two after-hours dinners, two potluck lunches, a private yoga session, and a campus farmer’s market trip. Food events and yoga reported highest attendance. Analysis used descriptive and comparative statistics.

Results

• Looking forward to work: 43.8% to 75.0% (+31.2 pts)
• Feeling isolated: 50.0% to 37.5% (decreased)
• Overall well-being: 50.0% to 87.5% (+37.5 pts)
• Job satisfaction: increased 18%
• 100% said PCAW improved community, well-being, and work-life balance

Conclusion

Coordinator-focused wellness initiatives can positively impact well-being, workplace engagement, and professional connectedness. The success of PCAW shows that meaningful wellness programming can be implemented with minimal financial investment while building a stronger sense of community among program coordinators. Further evaluation at future milestones will help determine the long-term sustainability and impact of these initiatives.

A Highly Qualified, Under-Empowered Workforce

72% of GME Directors hold a graduate or professional degree; 57% have worked in GME for more than a decade. Despite this, only 52% report having sufficient authority to fulfill their role. 36% answered “somewhat” and 12% reported lacking meaningful authority entirely.

Responsibility Without Recognition

Nearly all GME Directors are accountable for ACGME compliance (98%), budget oversight (86%), institutional goal execution (82%), and program growth (74%). Yet 75% spend most of their time on operational logistics, while formal evaluations rarely reflect these contributions.

Over 90% report experiencing burnout at least occasionally, with 25% reporting frequent burnout and 7% constant burnout.

Beyond the Job Description

GME Directors routinely serve as supervisors of coordinator teams, interpreters of evolving ACGME standards, collaborators with HR, Legal, and Risk Management, institutional memory during leadership turnover, and first responders during crises. These functions are critical yet rarely codified.

Dyad Leadership in Practice

The strongest institutions pair physician leaders with experienced GME administrators as equals. Administrative leaders must have seats at strategic tables, with evaluations reflecting their full scope of contribution.

Five Actions Institutions Must Take

• Clarify and standardize the GME Director role across titles and reporting lines.
• Include GME Directors in strategic decisions on workforce planning and growth.
• Align performance metrics with operational and leadership reality, not compliance alone.
• Invest in development: mentorship, TAGME certification, and leadership academies.
• Advance dyad partnerships with shared goals and co-led initiatives.

Call for Further Research

The 2025 GME Director Survey is an early effort to formally document the scope and challenges of GME administrative leadership. More data are needed on long-term program impact, burnout patterns, and best practices in dyad leadership.

Scale and Structure

The DoD oversees ACGME-accredited programs across Army, Navy, and Air Force medical centers. In 2024, approximately 2,600 physicians were trained annually. Admission typically flows through HPSP or USUHS. Trainees are commissioned officers with military service obligations.

Military vs. Civilian Programs

Both program types meet ACGME standards. Military programs add operational medicine, leadership development, and deployment preparation. Civilian programs offer larger patient volumes and broader subspecialties. Average civilian internal medicine programs train 30 to 50 residents annually; military 10 to 20.

Military Trainees in Civilian Programs

Approximately 15% of military GME trainees participated in civilian residencies in 2024. They remain commissioned officers balancing military obligations alongside civilian training demands. 90% of military-trained physicians report deployment readiness within six months of completing residency.

Recommendations: Medical Students

• Evaluate personal goals and readiness for service obligations before committing.
• Research specialty availability in both military and civilian pathways.
• Seek mentorship from current or former military physicians.

Recommendations: Educators

• Integrate operational medicine, leadership, and military ethics into curricula.
• Facilitate collaborative training between civilian and military institutions.

Background

GME coordinators serve as the link between trainees, faculty, and institutional leadership. In Puerto Rico, no centralized platform existed for coordinator communication or professional development, contributing to variability in administrative practices and isolated professional growth.

Objectives

• Facilitate peer-to-peer discussions.
• Share educational resources and best practices.
• Promote professional development opportunities and events.
• Encourage collaboration across institutions.

Methods

A Facebook group was independently created and administered. Platform selected for accessibility, user familiarity, and real-time communication capability. This shows that individual leadership can advance innovation in GME administration.

Results

• Over 25 members from multiple Puerto Rico institutions within three months.
• Active peer discussions and resource sharing across the group.
• Professional development events promoted to the membership.

Conclusion

Social media platforms can support meaningful professional engagement at minimal cost. This model is adaptable to other geographically or resource-limited settings. Future work includes workshops, webinars, and local conferences.

Why This Model Matters

Professional isolation drives burnout and turnover in GME administration. The PR GME Coordinators group addresses this at zero cost through a platform any coordinator team can replicate. It is both a regional solution and a scalable model for underserved GME communities worldwide.

Next Steps

• Develop structured workshops and webinars for Puerto Rico GME coordinators.
• Plan a local conference to advance professional development.
• Incorporate structured evaluation with participant feedback and engagement metrics.
• Explore expansion to other Spanish-speaking or geographically dispersed GME communities.

Scalability

Key replicable elements: zero startup cost, familiar platform, no institutional approval required, mobile-accessible, self-sustaining once engagement is established.

Pre-Competency Era

Before 2001, coordinator roles were primarily administrative: scheduling, communication, and event planning. A strong coordinator was an asset, not a requirement. Administrators often remained in roles for decades.

Core Competencies (2001)

The ACGME Outcome Project established six core competencies, increasing coordinator responsibility for oversight and documentation. Coordinators needed greater independence but received little formal orientation. Frustration built as workloads grew without recognition.

Milestones and NAS (2013)

Milestones and the Next Accreditation System launched simultaneously. Annual cycles replaced periodic site visits. ADS replaced the PIF. The 10-year Self Study was established. Coordinators took ownership of data entry and continuous accreditation with no formal recognition of the expanded workload.

Milestones 2.0 (2018)

Writing groups broadened to include program directors, faculty, trainees, and coordinators. Implementation required years of adjustment. Coordinators took on deeper roles in assessment than at any prior point.

The Coordinator Description Task Force (CDTF)

The CDTF was a grassroots effort run entirely by GME coordinators with no sponsorship. Its goal: petition the ACGME to include coordinator language in the Common Program Requirements. The task force collected data, documented responsibilities, proposed new language, and gathered a community-wide petition. Language was added to the CPRs, including FTE guidelines by program size. Special recognition to Lisa Schritz, C-TAGME, for her instrumental role.

Where the Profession Stands Today

• Formal recognition of the coordinator role within ACGME program requirements.
• Expanded training, mentorship, and professional development pathways.
• Stronger professional community driving career trajectory and recognition.